Even though melasma is not painful or damaging to your overall health, the symptomatic dark patches of skin can have a significant impact on your appearance. Melasma can be difficult to treat--especially since any exposure to the sun aggravates it--but it can also go away without treatment and usually only requires topical creams.

Melasma is a condition in which brown patches of pigment appear on the skin. It typically occurs on the cheeks, chin, forehead and upper lip but can appear in any area of skin exposed to sun. Melasma is most common in women and people with darker skin tone. When melasma appears during pregnancy--the “mask of pregnancy,” it is called chloasma.

The exact cause is not known, but genetics (a family history of melasma), female hormonal activity, photosensitivity and exposure to sunlight are the factors known to be associated with the appearance of melasma.

The best treatment is the least invasive option that works, and for melasma that means using a topical cream. Before starting treatment, it is important to understand that melasma develops gradually and treatment will also be a slow process, often taking several months for the discoloration to disappear. Melasma may fade without any treatment, especially if it’s related to hormones. If it appeared during pregnancy or while taking hormones, the discolorations may go away after delivery or when you discontinue medications with hormones. Stop using any skin care products that irritate your skin because they can also make the melasma worse.

No matter what treatment you choose, it will not be successful unless you avoid sunlight. All waves of sunlight can cause skin discoloration and affect treatment, so be sure to wear a sunscreen every day, even when it is cloudy. The American Academy of Dermatology recommends using a sunscreen that protects against UVA and UVB rays and has a sun protection factor of 30 or more. Physical sun-blocking agents--zinc oxide and titanium oxide--are more effective than chemical blockers.

Creams containing chemicals that diminish the discoloration are the first choice for treatment. A chemical called hydroquinone is frequently effective. It is available over-the-counter in 2 and 4 percent concentrations. Always begin with the smallest concentration because the risk of side effects, such as skin irritation and more pigmentation, increases with higher concentrations. Prescription medications are available containing hydroquinone (HQ), tretinoin, or a combination of HQ, tretinoin and a corticosteroid. Your physician may also consider an antibiotic cream called azelaic acid, which stops the hyperactive skin pigment.

Chemical peels, microdermabrasion and laser resurfacing are three treatment options that remove the outer layers of the skin. The theory is that new skin will not be hyperpigmented, so the melasma disappears as the fresh skin grows. Chemical peels usually take less than an hour and side effects (redness and pain) depend on the depth of the peel. Microdermabrasion treats only the top surface by removing dead skin using small crystals or other abrasive materials. Laser resurfacing uses laser light beams to remove the surface skin cells. Laser treatment requires a local anesthesia, the sessions last 30 to 90 minutes and some swelling or redness is to be expected. Be aware that swelling can have a side effect of hyperpigmentation, causing more darkening of the skin.